Update on the Management of Postoperative Peritonitis

Abstract

Postoperative peritonitis is defined as an infection of the peritoneal space following an initial abdominal surgery. The main causes are suture leaks, bowel perforation and one or several abscesses. The cultured microorganisms are Gram negative aerobes (Enterobacteriaceae and nonfermenting bacilli), Gram positive aerobes (streptococci, staphylococci, and enterococci), anaerobes (mainly bacteroides and clostridia), and fungi (essentially candidas). These organisms are frequently resistant to antibiotics or even multidrug resistant. The management of these complications is a therapeutic emergency. Diagnosis is often difficult and based on a body of evidence. CT scan is the key imaging technique. The other routine tests, including biological tests, are used only to assess the severity of the infection. Treatment is based on both surgical and medical management. Surgery is the etiological approach to identify and eliminate the source of infection, to draw microbiological samples, to perform an extensive peritoneal cleaning, and to avoid relapse. The medical management is based on supportive care. The antibiotic therapy is focused against the organisms cultured from surgical samples. Inadequate antibiotic therapy not targeting all the cultured pathogens is a risk factor of therapeutic failure, persisting infection or even death. The recommended duration of antibiotic therapy stands between 7 and 15 days.